Social inequalities and untreated dental caries in 5-year-old children: an intersectional analysis based on SB Brasil 2023ABSTRACT
Objective: To identify intersectional vulnerability profiles among 5-year-old children with untreated dental caries and to analyze associated social inequalities in Brazil.
Methods: This is a population-based, cross-sectional study using data from the National Survey of Oral Health (SB Brasil 2023). Five-year-old children examined in the survey were included. The variables used to identify profiles were: race/skin color, household income, maternal level of education, beneficiaries of social welfare programs, and region of residence. For profile comparison, the variables “last dental appointment” and “presence of piped water at home” were used. Descriptive, bivariate (χ²), Two-Step Cluster, and binary and multinomial logistic regression analyses were performed.
Results: A total of 7,185 children were analyzed, of whom 44.8% presented untreated dental caries. Higher prevalence values were observed among children with low maternal education (51.9%), Black (49.9%) and Indigenous (75.0%), low income (54.1%), living in the North (56.3%) region, and beneficiaries of social welfare programs (53.0%) (p<0.001). Three profiles were identified: Profile A (boys, Black, from the Northeast, low income, and high dependence on social welfare programs) showed lower probability of dental appointment in the past 2 years (OR 0.59; 95%CI 0.48-0.73; p<0.001); Profile B (boys, White, from the Northeast, low income, and beneficiaries of social welfare programs) showed worse conditions regarding the presence of piped water at home (OR 0.38; 95%CI 0.19-0.76; p=0.006); and Profile C (girls, Black, from the North, higher income, and lower dependence on social welfare programs) concentrated the best conditions for dental appointment and piped water (p<0.001).
Conclusion: Untreated dental caries among 5-year-old children reflects structural inequities combining racial, socioeconomic, territorial, and income-related inequalities.
Keywords:
Dental caries; Social determinants of health; Health inequalities; Intersectionality
RESUMO
Objetivo: Identificar perfis interseccionais de vulnerabilidade em crianças de 5 anos com cárie dentária não tratada e analisar desigualdades sociais associadas no Brasil.
Métodos: Estudo transversal de base populacional com dados do Levantamento Nacional de Saúde Bucal (SB Brasil) 2023. Foram incluídas crianças de 5 anos examinadas no inquérito. As variáveis utilizadas para identificação dos perfis foram: raça/cor, renda familiar, escolaridade da mãe, participação em programas sociais e região de residência. Para comparação entre perfis foram: última consulta com dentista e presença de água canalizada no domicílio. Realizaram-se análises descritivas, bivariadas (qui-quadrado), análise Two-Step Cluster e regressão logística binária e multinomial.
Resultados: Foram analisadas 7.185 crianças, das quais 44,8% apresentaram cárie dentária não tratada. As maiores prevalências ocorreram entre crianças com baixa escolaridade da mãe (51,9%), negras (49,9%) e indígenas (75%), de baixa renda (54,1%), do Norte (56,3%) e beneficiárias de programas sociais (53%) (p<0,001). Identificaram-se três perfis: Perfil A (meninos, negros, nordestinos, de baixa renda e alta dependência de programas sociais) apresentou menor probabilidade de consulta com dentista nos últimos 2 anos (OR 0,59; IC95% 0,48-0,73; p<0,001); Perfil B (meninos, brancos, nordestinos, de baixa renda e beneficiários de programas sociais) apresentou piores condições quanto à presença de água canalizada no domicílio (OR 0,38; IC95% 0,19-0,76; p=0,006); e Perfil C (meninas, negras, nortistas, com renda mais alta e menor dependência de programas sociais) concentrou as melhores condições de consulta e água canalizada (p<0,001).
Conclusão: Cárie dentária não tratada em crianças de 5 anos reflete iniquidades estruturais que combinam desigualdades de raça, classe, território e renda.
Palavras-chave:
Cárie dentária; Determinantes sociais da saúde; Desigualdades de saúde; Interseccionalidade
INTRODUCTION
Dental caries is one of the most prevalent chronic diseases in the world, generating relevant clinical, functional, and psychosocial impacts throughout life1. Despite being susceptible to prevention and treatment, its distribution is marked by important social, economic, and territorial inequalities, reflecting patterns of health inequities observed in both high and low-income countries2,3,4,5.
In 2019, approximately 514 million children had untreated dental caries in deciduous teeth worldwide, corresponding to an overall average prevalence of 43%, with values above 40% in more than 2/3 of the countries3. In the Brazilian context, dental caries persists as a priority harm in childhood, particularly at 5 years of age, the age group internationally used as a reference for epidemiological monitoring of early tooth decay and its consequences6,7.
There is evidence that the occurrence and persistence of dental caries are strongly associated with social determinants of health, which operate through gradients related to income, level of education, race/skin color, living conditions, access to drinking water, and availability of health services2,4,8,9. These determinants do not operate individually; on the contrary, they tend to overlap and interact with each other, producing more complex patterns of vulnerability as social markers - such as race/skin color, social class, and territory - accumulate3,5,8.
In this sense, the perspective of intersectionality, originally introduced by Crenshaw and later expanded into the field of collective health8, has emerged as a relevant reference to understand how inequality axes articulate themselves in the production of inequalities. In the field of oral health, authors of recent studies have advocated the incorporation of intersectionality into the study of inequalities, highlighting that explanations based on isolated determinants underestimate the complexity of the social processes involved8,10.
However, the application of intersectionality in the epidemiology of oral health is still limited. Most researchers adopt methodological approaches that deal with determinants as isolated variables, making it difficult to capture combined patterns of social disadvantage7. Within this context, clustering techniques, such as Two-Step Cluster, have been recommended as a methodological alternative to identify vulnerability profiles, allowing to analyze how social markers combine in the production of inequalities3. Although useful, these strategies remain underused in the dental literature, especially in childhood.
The Brazilian reality offers a relevant context for such analyses. The country has profound racial, territorial, and socioeconomic inequalities historically structured, which have repercussions on the use, opportunity, and problem-solving capacity of oral health care6,9. Authors have recently suggested that Black, Indigenous, poor children or those living in underdeveloped regions face accumulated barriers to dental care, even in the context of the Brazilian Unified Health System (SUS)4.
In addition, according to national data, the prevalence of 5-year-old children with at least one deciduous tooth with untreated dental caries decreased from 53.4% in 2010 to 41.2% in 2023, showing a reduction in the period, but with persistence of important social and territorial inequalities5.
In this context, the National Survey of Oral Health (SB Brasil 2023) represents an opportunity to investigate inequalities in oral health in childhood, given its national scope, standardized methodology, and availability of social, clinical, and care variables5. Nonetheless, intersectional analyses based on this database have not yet been explored.
Considering the identified gaps, in the present study, we aim to identify intersectional profiles of vulnerability in 5-year-old children with untreated dental caries and to analyze their social inequalities.
METHODS
Study design
This is a cross-sectional, population-based, and analytical study based on data from SB Brasil 2023.
Study participants
The study population was composed of children of both sexes, aged 5 years, examined in the survey (national sample, representative by Federation Unit [FU], region, capital/small cities); records with absence of data on dental caries experience, inconsistencies in the forms, or lack of information in the essential demographic, socioeconomic, and territorial variables were excluded.
Variables
The decayed, extracted, and filled teeth (deft) index, which quantifies decayed, missing, and filled deciduous teeth, was used as an indicator of dental caries experience. Children with deft=0 were classified as “without tooth decay.” For the “≥1 decayed tooth” classification, only the “decayed” component of the index was used, considering the presence of at least one deciduous tooth with active caries (d>0).
For the identification of intersectional profiles, only records of children with untreated dental caries were considered (decayed component >0). Social and demographic variables were selected based on the literature on social determination of health and intersectionality, including the categorical variables race/skin color (white, Black11 [Black and mixed-race], Asian, and Indigenous); monthly household income (less than 1 minimum wage, from 1 to 2 minimum wages, and more than 2 minimum wages); maternal level of education (illiterate/Youth and Adult Education [Educação de Jovens e Adultos - EJA], incomplete or complete Elementary School, incomplete or complete High School, incomplete or complete Higher Education); region of residence (North, Northeast, Midwest, Southeast, and South); and beneficiary of social welfare programs (yes or no), including the Bolsa Família Program and the Continuous Cash Benefit (cash transfer programs of the Brazilian government).
After creating the profiles, comparative analyses were carried out between the identified groups using variables related to living conditions and access to services, considering the last dental appointment (has never visited a dentist, in the last 2 years, and over 2 years ago), employed as a proxy for access to care, and the presence of piped water at home (with plumbing or without plumbing), used as a proxy of household infrastructure.
The categories followed the standardization of SB Brasil 2023 and were kept in the original form or clustered according to epidemiological relevance12,13.
Data source
The used data derive from SB Brasil 2023. Crude data from SB Brasil 2023 were obtained from the General Coordination of Oral Health of the Brazilian Ministry of Health, upon formal request. This database gathers demographic, socioeconomic, territorial, clinical and dental services information collected in a standardized way throughout the country.
To evaluate the quality of the data and reduction of potential biases, checks of completeness and logical consistency of the information were carried out. Records referring to children without information on the deft index or with inconsistencies in the answers were excluded prior to the statistical analysis.
Study sample
All records available for the period were considered, ensuring the representativeness of the sample. This approach avoided random sampling, as the data were secondary and covered a significant universe of the target population.
Statistical methods
In the descriptive analysis, absolute and relative frequencies of the demographic, socioeconomic, territorial, and clinical-care characteristics of the total sample were calculated. The bivariate associations between the presence of dental caries and social markers were tested in the total sample by Pearson’s χ² test, adopting a 5% significance level.
To identify intersectional vulnerability profiles, a Two-Step Cluster analysis was performed using the previously specified social and demographic variables. The log-likelihood distance measure was used, and the Bayesian Information Criterion (BIC) guided the selection of the optimal number of clusters. The resulting profiles were described according to their predominant characteristics.
Subsequently, differences between the profiles were investigated regarding living conditions and access to care. These analyses were exclusively conducted among the individuals classified in the profiles, considering that the latent variable “profile” is not attributable to incomplete cases and cannot be imputed without distorting the probabilistic structure of the clusters.
Binary logistic regression was used for the variable “piped water at home” (reference: without plumbing) and multinomial logistic regression was considered for the variable “dental appointment” (reference: has never visited a dentist). The reference categories were chosen because they represent situations of greater vulnerability and are epidemiologically relevant as a comparative baseline.
Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated. The models were estimated in an unadjusted way, as the profiles result from the simultaneous combination of the social markers previously incorporated into the cluster analysis, and it is not necessary to include these same markers as additional covariates in the subsequent models.
All statistical analyses were performed using the IBM SPSS Statistics software, version 23.0 (IBM Corp., Armonk, NY, United States), and were conducted without sampling weights, as it is an internal exploration of social profiles and not population estimates.
The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology)14 recommendations, according to which transparency and completeness are recommended in the presentation of observational studies.
Data Availability Statement
The entire dataset that supports the results of this study is available upon request to the corresponding author. The dataset is not publicly available due to the integration of databases carried out by the authors.
RESULTS
Of the total of 40,720 individuals registered in SB Brasil 2023, 7,198 were children aged 5 years, of which 7,185 (17.6%) were included in the analysis after the exclusion of 13 records without information on the deft index.
In the demographic, socioeconomic, and territorial profile (Table 1), we observed a balanced distribution between sexes (51.1% boys; 48.9% girls) and predominance of residents in the Northeast (36.6%) and North (24.6%) regions. Regarding race/skin color, 61.9% were classified as Black (Black and mixed-race) and 34.6% as white. As for maternal level of education, 40.7% had complete or incomplete High School and 15.5% had Higher Education degree. In addition, 48.7% of families were beneficiaries of social welfare programs. From the clinical-care point of view, 40.1% of the children had never visited a dentist, and 44.8% had untreated dental caries.
In the bivariate analysis (Table 2), we verified a significant association between untreated dental caries and sex, region, race/skin color, maternal level of education, household income, and beneficiaries of social welfare programs and presence of piped water at home (p<0.05).
The prevalence of dental caries was higher among boys (46%) than among girls (43.6%); among residents of the North (56.3%) and Northeast (46.2%) regions, compared to the Southeast (31.6%) and South (34.5%); among Indigenous (75%) and Black (49.9%) children, compared to white (35.4%). The lowest prevalence occurred among children of mothers with Higher Education degree (27.9%), while the highest prevalence occurred among children of mothers with Elementary Education (51.9%). The prevalence was also higher in families with household income less than 1 minimum wage (54.1%), in beneficiaries of social welfare programs (53%), and in households without piped water (59.6%) (p<0.001). The variable “last dental appointment” did not present a statistically significant association with dental caries (p=0.715) (Table 2).
In the Two-Step Cluster analysis (Table 3), variables with greater weight for defining the profiles were beneficiary of social welfare programs, race/skin color, and household income, while region, maternal level of education, and sex had lower influence. We identified three intersectional profiles: Profile A, composed mainly of boys (55.7%), from the Northeast (49.4%), Black (100%), children of mothers with incomplete or complete High School (45.3%), with household income less than 1 minimum wage (66%), and beneficiaries of social welfare programs (95.9%); Profile B, composed mainly of boys (50.2%), from the Northeast (41.5%), white (92%), children of mothers with incomplete or complete High School (52.3%), with household income less than 1 minimum wage (63.1%), and beneficiaries of social welfare programs (90.8%); and Profile C, composed mainly of girls (51.2%), from the North (31.4%), Black (64.4%), daughters of mothers with incomplete or complete High School (45%), with household income greater than 2 minimum wages (43.8%), and who were not beneficiaries of social welfare programs (91.3%).
In the comparison between profiles and indicators of access and living conditions (Table 4), children of Profile C presented a higher proportion of recent dental visits, while Profiles A and B concentrated the lower frequencies of use of services. Concerning household infrastructure, Profile B presented a higher proportion of households without piped water.
According to logistic regression analyses (Table 5), Profiles A and B presented lower odds of access to dental services and piped water compared to Profile C. The difference was more pronounced in Profile A for dental access and Profile B for access to piped water.
DISCUSSION
In this study, we verified a high prevalence of untreated dental caries in 5-year-old children in Brazil, with higher frequencies among Black and Indigenous children, from the North and Northeast regions, with low income, and beneficiaries of social welfare programs. As per the intersectional analysis, we identified three distinct vulnerability profiles, with Profile A being the most vulnerable and Profile C, the least vulnerable. We observed a lower probability of dental appointment and worse access to piped water among the most vulnerable profiles.
The unequal distribution of untreated dental caries in the country indicates that this disease reflects structural patterns of inequality, as already pointed out by authors of national and international investigations that associate the disease with conditions of social vulnerability4,10,15,16,17. Considering the high prevalence observed, especially in the North and Northeast regions and among Black and Indigenous children, failure to tackle the disease reflects the persistence of structural inequalities in the supply and access to dental care18,19,20. These results suggest that untreated dental caries, more than a clinical issue, is a concrete expression of social determination of health21,22,23,24.
The intersectional analysis of the data, operationalized by the identification of three vulnerability profiles, reinforces this understanding. Profile A, predominantly composed of Black children, of low income, low maternal education, mostly residents in the Northeast, and with high dependence on social welfare programs, represents the point of great social vulnerability25,26. The overlapping of racial, economic, and territorial markers constitutes greater vulnerability to the nontreatment of dental caries, which is compatible with studies whose authors point to structural barriers in access and continuity of care for historically marginalized populations6,9,18,19,20.
Profile B, mainly composed of white children, presented socioeconomic vulnerability and greater absence of piped water, indicating that poverty constitutes structural barriers to oral health27. However, it differs from Profile A, in which economic vulnerability is added to racial and territorial markers, thus increasing the inequalities8,10. In the Brazilian context, there is evidence that poverty is not experienced in a homogeneous way between racial groups, reflecting intersectional effects of skin color/race and class28.
Profile C, although with better economic and access conditions, is not exempt from the marks of racial inequality, which demonstrates that race remains a structuring axis of care opportunities, as discussed in studies whose authors apply the concept of intersectionality to oral health10,25,29,30.
Untreated dental caries results, therefore, from the accumulation of social disadvantages. The direct association with low income, low maternal education, and dependence on social welfare programs corroborates that dental treatment, even in the context of SUS, is not carried out in a universal or equitable way27,31,32. Families in poverty have less conditions to access preventive and rehabilitation services in addition to facing logistical, cultural, and institutional barriers33,34.
Low family education limits the ability to understand the importance of early care, while economic vulnerability restricts time and means to seek care35,36. Although the maternal level of education was associated with untreated dental caries in the present study, it is worth noting the relatively homogeneous distribution of this variable in the sample, with predominance of complete or incomplete High School and presence of a portion with Higher Education. This composition decreases the educational contrast between subgroups, which may have reduced their discriminatory power in the creation of profiles. This finding is consistent with changes in recent decades related to the expansion of women’s education in Brazil, in which higher formal levels of education can coexist with economic and racial vulnerability37,38.
The relationship between household infrastructure and oral health is worthy of attention. The absence of piped water was associated with higher prevalence of untreated dental caries, indicating that material living conditions are part of the set of factors that shape the possibility of adequate oral hygiene and use of inputs such as fluoride toothpaste5,16. In this sense, the observed disease cannot be interpreted only in clinical terms, but as an expression of structural inequalities in access to basic rights, particularly relevant in early childhood21,26.
Another relevant finding was the absence of an association between dental appointment and not presenting untreated dental caries. This result suggests that oral health care in childhood does not depend exclusively on occasional contact with the dental service, but on factors that involve continuity of care, organization of the care network, health education, family support, and living conditions. The appointment alone does not ensure the problem-solving capacity of the care, which is compatible with analyses whose authors point to structural and organizational limitations in primary care, suppressed demands, and practices centered on emergency and mutilating procedures18,19,27,28,31,39.
Untreated dental caries can be understood, therefore, as an expression of inequities in care, and not just as prevention failure. While initial access to services may have expanded, the problem-solving and continuity capacity is still uneven29. The nontreatment of the disease thus represents the final stage of exclusion: getting sick and not being treated. This phenomenon evidences a qualitative inequality, a “problem-solving capacity inequity,” in which vulnerable groups have less chance to complete treatment and achieve rehabilitation.
The fact that the variables race/skin color, maternal level of education, income, and social welfare program have greater weight in the formation of untreated dental caries profiles than clinical or care factors reinforces the understanding of social determination of oral health5,22,35,36. Intersectionality contributes to understanding that these processes do not act alone - the effect of poverty is aggravated by racism, and both are intensified by territorial contexts of exclusion. This approach breaks with traditional perspectives that isolate variables, showing that social determinants interact with each other30,32.
Childhood is a period when inequalities can manifest early. The presence of untreated dental caries at the age of 5 represents not only an immediate clinical problem, but an indicator of early accumulation of vulnerabilities that may affect school development, self-esteem, nutrition, and general well-being24,40. The persistence of these inequalities since early childhood points to a process of generational injustice, in which adverse social conditions in childhood shape more unequal life trajectories35.
This study presents limitations inherent in the use of secondary data from SB Brasil 20235, such as dependence on standardized information and lack of broader contextual variables, for example, coverage of oral health teams, primary care characteristics, and local environmental indicators21,35. In addition, the variable “last dental appointment” does not allow to distinguish the type of care (preventive, curative, or emergency), which can underestimate qualitative inequalities in care18.
Another relevant aspect refers to the structure of the analyzed variables, which have different levels (family, household, and territorial) and were modeled on the same individual level, which can generate loss of contextual information. Furthermore, the cross-sectional nature of the study makes it impossible to establish causal relationships between social determinants and the experience of untreated dental caries, and findings should be interpreted with caution.
As a strength, we mention the use of a national database, standardized methodology, and application of intersectional analysis by the Two-Step Cluster analysis, which empirically operationalized social and racial dimensions in the field of oral health25,29,30. This strategy allowed us to capture the intertwining of social and racial dimensions, offering a more deep and contextualized view of iniquities. Future studies may advance by incorporating contextual variables, such as the density of oral health teams, coverage of the Family Health Strategy (FHS), and indicators of urban infrastructure, to understand broader levels of social determination21,27.
The present findings have direct implications for public policies. Coping with untreated dental caries requires strategies that combine clinical actions with structural interventions36,41. It is necessary to strengthen primary care in oral health, increase water fluoridation, develop anti-racist and intersectional educational actions, and ensure longitudinal follow-up of the most vulnerable children22,23,42,43. Policies must explicitly recognize the social markers of inequality, incorporating racial, territorial, and social equity as criteria for prioritization.
Untreated dental caries is, therefore, a mirror of Brazilian inequalities, being concentrated among Black, poor children from the North and Northeast regions, which points to an unequal distribution of the right to health and childhood4,16,26,32. According to the profile analysis, the intersection of social markers - such as race/skin color, income, maternal education, and territory - is not additive, but produces specific arrangements of vulnerability, reaffirming that the disease expresses the social determination of health. Moreover, to combat the disease, there must be public policies on racial, territorial and social equity and a SUS capable of reducing inequalities since the first years of life.
REFERENCES
-
1. Oliveira RP, Delevatti L, Pinto MSM, Gebara FD. Saúde bucal e qualidade de vida: uma revisão integrativa. Rev Novos Desafios 2025; 5 (1): 82-93. https://doi.org/10.5281/zenodo.15659203
» https://doi.org/https://doi.org/10.5281/zenodo.15659203 - 2. Bueno RE, Moysés ST, Bueno PAR, Moysés SJ. Determinantes sociais e saúde bucal de adultos nas capitais do Brasil. Rev Panam Salud Publica 2014; 36(1): 17-23.
- 3. World Health Organization. Global Oral Health Status Report: towards universal health coverage for oral health by 2030. Geneva: WHO; 2022.
-
4. Moura RNV, Paiva SM, Ramos-Jorge J, Pinto RS, Lara JVI, Barbosa MCF, et al. Social inequities and dental caries in 5-year-old children: a study with results from SB Brasil 2023. Braz Oral Res 2025; 39(suppl 1): e046. https://doi.org/10.1590/1807-3107bor-2025.vol39.0046
» https://doi.org/https://doi.org/10.1590/1807-3107bor-2025.vol39.0046 -
5. Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Estratégias e Políticas de Saúde Comunitária. SB Brasil 2023: Pesquisa Nacional de Saúde Bucal: relatório final [Internet]. Brasília: Ministério da Saúde; 2025 [cited on Oct. 02, 2025]. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/sb_brasil_2023_relatorio_final_1edrev.pdf
» https://bvsms.saude.gov.br/bvs/publicacoes/sb_brasil_2023_relatorio_final_1edrev.pdf -
6. Narvai PC, Frazão P. Saúde bucal no Brasil: muito além do céu da boca. Rio de Janeiro: Fiocruz; 2008. https://doi.org/10.7476/9788575413630
» https://doi.org/https://doi.org/10.7476/9788575413630 -
7. Nunes VH, Perosa GB. Cárie dentária em crianças de 5 anos: fatores sociodemográficos, lócus de controle e atitudes parentais. Ciênc Saúde Colet 2017; 22(1): 191-200. https://doi.org/10.1590/1413-81232017221.13582015
» https://doi.org/https://doi.org/10.1590/1413-81232017221.13582015 -
8. Couto MT, Oliveira E, Separavich MAA, Luiz OC. La perspectiva feminista de la interseccionalidad en el campo de la salud pública: revisión narrativa de las producciones teórico-metodológicas. Salud Colect 2019; 15: e1994. https://doi.org/10.18294/sc.2019.1994
» https://doi.org/https://doi.org/10.18294/sc.2019.1994 -
9. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Coordenação Nacional de Saúde Bucal. Diretrizes da Política Nacional de Saúde Bucal [Internet].; 2004 [cited on Oct. 02, 2025]. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_brasil_sorridente.pdf
» https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_brasil_sorridente.pdf -
10. Alencar JVA, Carvalho DPC, Umeno HG, França MASA, Azevedo MN. Análise interseccional da vulnerabilidade social de pessoas com diferenças no intervalo entre o diagnóstico e o tratamento do câncer de boca: estudo transversal, Brasil, 2011-2020. Epidemiol Serv Saude 2025; 34: e20240849. https://doi.org/10.1590/S2237-96222025v34e20240849.pt
» https://doi.org/https://doi.org/10.1590/S2237-96222025v34e20240849.pt -
11. Santos RV, Bastos JL, Kaingang JD, Batista LE. Cabem recomendações para usos de “raça” nas publicações em saúde? Um enfático “sim”, inclusive pelas implicações para as práticas antirracista. Cad Saúde Pública 2022; 38(3): e00021922. https://doi.org/10.1590/0102-311X00021922
» https://doi.org/https://doi.org/10.1590/0102-311X00021922 -
12. Vargas AMD, Teixeira DSC, Alves MCGP, Alencar GP, Bernal RTI, Vasconcelos M, et al. Methodological aspects of national surveys in Brazil: contributions to the debate on oral health surveillance. Braz Oral Res 2025; 39 (suppl 1): e043. https://doi.org/10.1590/1807-3107bor-2025.vol39.043
» https://doi.org/https://doi.org/10.1590/1807-3107bor-2025.vol39.043 -
13. Vargas AMD, Teixeira DSC, Ferreira RC. SB Brasil 2023: methodological insights and key oral health findings. Braz Oral Res 2025; 39(suppl 1): e051. https://doi.org/10.1590/1807-3107bor-2025.vol39.051
» https://doi.org/https://doi.org/10.1590/1807-3107bor-2025.vol39.051 -
14. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596): 1453-7. https://doi:10.1016/S0140-6736(07)61602-X
» https://doi.org/https://doi:10.1016/S0140-6736(07)61602-X -
15. Paredes SO, Nóbrega RF, Soares TS, Bezerra MED, Abreu MHNG, Forte FDS. Dental pain associated with untreated dental caries and sociodemographic factors in 5-year-old children. J Clin Exp Dent 2021; 13(6): e552-e557. https://doi.org/10.4317/jced.57827
» https://doi.org/https://doi.org/10.4317/jced.57827 -
16. Pelegrom J, Pickett K, Kostbade G, Tiwari T. Social vulnerability index and dental caries in children: an exploratory study. JDR Clin Trans Res 2025; 10(2): 190-7. https://doi:10.1177/23800844241279566
» https://doi.org/https://doi:10.1177/23800844241279566 -
17. Costacurta M, Epis M, Docimo R. Evaluation of DMFT in paediatric patients with social vulnerability conditions. Eur J Paediatr Dent 2020; 21(1): 70-3. https://doi:10.23804/ejpd.2020.21.01.14
» https://doi.org/https://doi:10.23804/ejpd.2020.21.01.14 -
18. Vieira-Andrade RG, Pordeus IA, Ramos-Jorge ML, Drumond CL, Silva-Freire LC, Ramos-Jorge J, et al. Risk indicators of untreated dental caries incidence among preschoolers: a prospective longitudinal study. Braz Oral Res 2022; 36: e064. https://doi.org/10.1590/1807-3107bor-2022.vol36.0064
» https://doi.org/https://doi.org/10.1590/1807-3107bor-2022.vol36.0064 -
19. Melo MMDC, Souza WV, Goes PSA. Increase in dental caries and change in the socioeconomic profile of families in a child cohort of the primary health care in Northeast Brazil. BMC Oral Health 2019; 19(1): 183. https://doi.org/10.1186/s12903-019-0871-9
» https://doi.org/https://doi.org/10.1186/s12903-019-0871-9 -
20. Moura RNV, Zarzar PMP, Ferreira RC, Mattos FF, Pinto RS, Travassos DV, et al. Regional differences in early childhood dental caries in 5-year-old Brazilian children and associated factors. Res Soc Dev 2021; 10(1): e43510111946. https://doi.org/10.33448/rsd-v10i1.11946
» https://doi.org/https://doi.org/10.33448/rsd-v10i1.11946 -
21. Boing AF, Bastos JL, Peres KG, Antunes JLF, Peres MA. Social determinants of health and dental caries in Brazil: a systematic review of the literature between 1999 and 2010. Rev Bras Epidemiol 2014; 17 Suppl 2: 102-15. https://doi.org/10.1590/1809-4503201400060009
» https://doi.org/https://doi.org/10.1590/1809-4503201400060009 -
22. Ramos-Gomez F, Kinsler JJ. Addressing social determinants of oral health, structural racism and discrimination and intersectionality among immigrant non-English speaking Hispanics in the United States. J Public Health Dent 2022; 82 Suppl 1: 133-9. https://doi.org/10.1111/jphd.12524
» https://doi.org/https://doi.org/10.1111/jphd.12524 -
23. Arantes R, Welch JR, Tavares FG, Ferreira AA, Vettore MV, Coimbra Jr CEA. Human ecological and social determinants of dental caries among the Xavante Indigenous population in Central Brazil. PLoS One 2018; 13(12): e0208312. https://doi.org/10.1371/journal.pone.0208312
» https://doi.org/https://doi.org/10.1371/journal.pone.0208312 -
24. Martins MT, Sardenberg F, Vale MP, Paiva SM, Pordeus IA. Dental caries and social factors: impact on quality of life in Brazilian children. Braz Oral Res 2015; 29(1): S1806-83242015000100310. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0133
» https://doi.org/https://doi.org/10.1590/1807-3107BOR-2015.vol29.0133 -
25. Raymundo MLB, Araújo ECF, Silva RO, Lira Neto AC, Menezes LXB, Lucena EHG, et al. Prevalence of dental caries and associated factors in children from a quilombola territory: an intersectional analysis. BMC Public Health 2025; 25(1): 3453. https://doi:10.1186/s12889-025-24786-7
» https://doi.org/https://doi:10.1186/s12889-025-24786-7 -
26. Jamieson L, Peres MA, Guarnizo-Herreño CC, Bastos JL. Racism and oral health inequities: an overview. EClinicalMedicine 2021; 34: 100827. https://doi.org/10.1016/j.eclinm.2021.100827
» https://doi.org/https://doi.org/10.1016/j.eclinm.2021.100827 -
27. Amaral Junior OL, Fagundes MLB, Hugo FN, Kassebaum NJ, Giordani JMA. Structural determinants of inequalities in untreated dental caries in the Global Burden of Disease Study. PLoS One 2025; 20(6): e0325138. https://doi.org/10.1371/journal.pone.0325138
» https://doi.org/https://doi.org/10.1371/journal.pone.0325138 -
28. Abreu MHNG, Cruz AJS, Borges-Oliveira AC, Martins RC, Mattos FF. Perspectives on social and environmental determinants of oral health. Int J Environ Res Public Health 2021; 18(24): 13429. https://doi.org/10.3390/ijerph182413429
» https://doi.org/https://doi.org/10.3390/ijerph182413429 -
29. Muirhead VE, Milner A, Freeman R, Doughty J, Macdonald ME. What is intersectionality and why is it important in oral health research? Community Dent Oral Epidemiol 2020; 48(6): 464-70. https://doi.org/10.1111/cdoe.12573
» https://doi.org/https://doi.org/10.1111/cdoe.12573 -
30. Slack-Smith L, Ng T, Macdonald ME, Durey A. Rethinking oral health aging: ecosocial theory and intersectionality. J Dent Res 2023; 102(8): 844-8. https://doi.org/10.1177/00220345231175061
» https://doi.org/https://doi.org/10.1177/00220345231175061 -
31. Albuquerque LS, Queiroz RG, Abanto J, Bönecker MJS, Forte FDS, Sampaio FC. Dental caries, tooth loss and quality of life of individuals exposed to social risk factors in Northeast Brazil. Int J Environ Res Public Health 2023; 20(17): 6661. https://doi.org/10.3390/ijerph20176661
» https://doi.org/https://doi.org/10.3390/ijerph20176661 -
32. Brondani B, Knorst JK, Ardenghi TM, Mendes FM, Brondani MA. Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: a 10-year cohort study. Community Dent Oral Epidemiol 2024; 52(4): 540-9. https://doi.org/10.1111/cdoe.12950
» https://doi.org/https://doi.org/10.1111/cdoe.12950 -
33. Yousaf M, Aslam T, Saeed S, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Individual, family, and socioeconomic contributors to dental caries in children from low- and middle-income countries. Int J Environ Res Public Health 2022; 19(12): 7114. https://doi:10.3390/ijerph19127114
» https://doi.org/https://doi:10.3390/ijerph19127114 -
34. Knorst JK, Tomazoni F, Sfreddo CS, Vettore MV, Hesse D, Ardenghi TM. Social capital and oral health in children and adolescents: a systematic review and meta-analysis. Community Dent Oral Epidemiol 2022; 50(6): 461-8. https://doi:10.1111/cdoe.12714
» https://doi.org/https://doi:10.1111/cdoe.12714 -
35. Do LG, Song YH, Du M, Spencer AJ, Ha DH. Socioecological determinants of child oral health: a scoping review. Community Dent Oral Epidemiol 2023; 51(5): 1024-36. https://doi:10.1111/cdoe.12819
» https://doi.org/https://doi:10.1111/cdoe.12819 -
36. van Meijeren-van Lunteren AW, You Y, Raat H, Wolvius EB, Kragt L. Caries preventive interventions and oral health inequalities: a scoping review. JDR Clin Transl Res 2023; 8(4): 311-25. https://doi:10.1177/23800844221109116
» https://doi.org/https://doi:10.1177/23800844221109116 -
37. Instituto Brasileiro de Geografia e Estatística. Prévia da população dos municípios com base nos dados do censo demográfico 2022 [Internet]. 2022 [cited on Oct. 18, 2025]. Available at https://censo2022.ibge.gov.br/etapas/divulgacao-dos-resultados.html
» https://censo2022.ibge.gov.br/etapas/divulgacao-dos-resultados.html -
38. Salata AR, Bringhenti TFS, Miranda ACH. Origem social e acesso ao ensino superior no Brasil entre 1992 e 2022. Dados 2025; 68(3): e20230188. https://doi:10.1590/dados.2025.68.3.376
» https://doi.org/https://doi:10.1590/dados.2025.68.3.376 -
39. Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol 2012; 40(4): 289-96. https://doi.org/10.1111/j.1600-0528.2012.00680.x
» https://doi.org/https://doi.org/10.1111/j.1600-0528.2012.00680.x -
40. Sabel N, Ylander LO, Stahlberg SE, Robertson A. Dental caries and oral health-related quality of live in preschoolers - introducing the Swedish version of the early childhood oral health impact scale (ECOHIS). Acta Odontol Scand 2024; 83: 47-53. https://doi:10.1080/00016357.2023.2287235
» https://doi.org/https://doi:10.1080/00016357.2023.2287235 -
41. Krol DM, Whelan K. Maintaining and improving the oral health of young children. Pediatrics 2023; 151(1): e2022060417. https://doi:10.1542/peds.2022-060417
» https://doi.org/https://doi:10.1542/peds.2022-060417 -
42. Teixeira AKM, Souza Júnior PRB. Evolution of socioeconomic inequalities in oral health and use of dental services in adult population of Brazil between 2013 and 2019. Cad Saude Publica 2025; 41(8): e0016324. https://doi.org/10.1590/0102-311XEN162324
» https://doi.org/https://doi.org/10.1590/0102-311XEN162324 -
43. Chaffee BW, Rodrigues PH, Kramer PF, Vítolo MR, Feldens CA. Oral health-related quality-of-life scores differ by socioeconomic status and caries experience. Community Dent Oral Epidemiol 2017; 45(3): 216-24. https://doi:10.1111/cdoe.12279
» https://doi.org/https://doi:10.1111/cdoe.12279
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HOW TO CITE THIS ARTICLE:
Azevedo MN, Alencar JVA, França MASA, Melo MVR, Santos MR, Mendes GAM, et al. Social inequalities and untreated dental caries in 5-year-old children: an intersectional analysis based on SB Brasil 2023. Rev Bras Epidemiol. 2026; 29 (Suppl 1): e260014supl1. https://doi.org/10.1590/1980-549720260014.supl.1.2
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FUNDING:
none.
Edited by
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ASSOCIATE EDITOR:
Yuri Wanderley Cavalcanti http://orcid.org/0000-0002-3570-9904
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SCIENTIFIC EDITOR:
Antonio Fernando Boing http://orcid.org/0000-0001-9331-1550
